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THE EDITOR'S CORNER

Expense or Investment?

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Expense or Investment?

Did you ever have one of those days when it seemslike the only things that don't go wrong are the ones thatjust don't happen at all? Not too long ago, I had a coupleof those days almost back to back. First thing one drearyMonday morning, my compressor went down. Like manyorthodontists, I am totally dependent on the compressorto run the handpiece for a plethora of chores: pumicingbefore bonding, removal of composite flash, air-rotorstripping to gain space, esthetic recontouring of incisaledges, composite removal after debonding, and right oninto retainer adjustment. Add to that the number of timesthe triplex syringe is used to rinse and dry my variousfields of operation. So when my compressor went down,it was a major inconvenience to everyone concerned--me, my staff, and my patients. Fortunately, this dilemmawas resolved within a week, thanks to the presence of acheap backup compressor that I learned long ago to keepon hand (about $300 at any hardware store) and a reliableequipment dealer who could supply a new one posthaste.

As we were getting over that incident, the secondcatastrophe struck, this time with a much higher level andlonger duration of inconvenience. Gina, my top assistant,the young lady I depended on to keep everything frompatients to inventory to carpet cleaning scheduled andflowing smoothly, had the audacity to quit her job withme to marry a promising, devoted, and loving young manwho had a great job in a distant city. Since Gina knew allthe subtle nuances of our patients' schedules (Maria haspiano lessons every Wednesday afternoon, so she cannever be scheduled then; Mrs. Campos can't get Louis tothe office before 5 p.m. any day of the week, so we haveto stay a little longer on a Thursday every four to sixweeks), these details had to be relearned, first by me andthen by Sonia, Gina's able replacement. Our practiceinventory went wildly out of control. Just when I thoughtI would never have the right items on my procedure traysand the carpets would never be cleaned again, Soniacaught on. Eventually, our office life returned to normal,but it probably took all of a year.

What brought these twin disasters to mindwas a statement I heard the other day with regardto office expenses. The speaker at this particularbusiness seminar was expounding on the issuethat employees--personnel--are the singlegreatest expense in any commercial operation.My initial gut reaction was, "Well, some moneyis just well spent." But on further reflection, itwas exceedingly difficult for me even to think ofeither Gina or Sonia (or any of my other employees)as "expenses". In many ways, they are mypartners in practice. While they do not have fiscalequity in the assets of the corporation, they dohold a real stake in the ownership of the practice.The patients see me as the central authority figureof the practice, the doctor who holds the keysto their successful treatment. Though their visualacuity may be questionable, they see me as thebrains of the operation. On the other hand, theysee Gina and Sonia and the other staff as theheart and smile of the operation. Theirs are thepersonalities that really define our practicepatientrelationships. To draw a different analogy,I set the overall tone and establish the gameplan, but the members of my office staff are thekey players who make it all work. How can Iconsider them merely "expenses"?

My compressor was an expense. I paid ahandsome sum for it when I set up my practice. Ipaid for regular maintenance on it until it woreout. I then paid to have it replaced. If my accountingpractices were fastidious enough, Icould figure out the proportion of my total practiceexpenses attributable to my compressor. Mystaff, on the other hand, is a genuine investment.Even when my practice management consultantcomes up with a formula that predicts the increasein office production per unit of "staff hourexpenditure", this estimate pales in comparisonwith the true return on investment I receive froma capable and devoted staff member. I get happypatients who have fun when they come to theoffice. I get satisfied parents who recommendour office to their friends. I get a tremendousreduction in my level of work-related personalstress. In short, I get a well-functioning officethat runs more like a happy family and less like asoulless business machine.

To be sure, I have visited many offices thatoperate more efficiently and effectively using amuch stricter business management model thanmine, but even in those practices, the investmentin human capital is critical. My initial outlay forthe compressor was followed by relatively minormaintenance fees, making it, for all practical purposes,a one-time expense. Human capital, on theother hand, like all true investments, flourishesbest with periodic reinvestment--continuingeducation, travel to professional meetings, retirementplans, medical insurance, and so on.

To my mind, orthodontic staff members arewell worth not only the initial investment, but thecontinuing reinvestment. My calamitous weekwas a case in point: When our compressor failed,Gina rapidly resolved the crisis; when we lostGina, the compressor couldn't do a thing to help.

ROBERT G. KEIM, DDS, EDD, PHD

Editor-in-Chief, JCO

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